<cfoutput>
	#dspDocumentHeader()#
	<h2>Daily Summary Report <span class="caption">COMAR 10.21.26.07 B(1-2)</span></h2>
	<cfif PARAMS.key NEQ 0>#dspFormButtons(key=PARAMS.key, action=PARAMS.controller)#</cfif>
	<fieldset>
		<table width="90%">
			<tr>
				<th class="left">Consumer Name: <span style="font-weight: normal;"><!--- #Consumer.firstName# #Consumer.lastName# ---></span></th>
				<th class="right">Date: <input type="text" class="date" /></th>
			</tr>
		</table>
		
		<dl>
			<dt>Danger to Self or Others: <input type="radio" /> No <input type="radio" /> Yes</dt>
			<dt class="list">Monitor for Suicidal/Homicidal Ideation: <input type="radio" /> Every 30 Mins <input type="radio" /> Hourly <input type="radio" /> Every 3 Hours</dd>
			<dt>Stable Medical Condition: <input type="radio" /> No <input type="radio" /> Yes</dt>
			<dt class="list">Referral To: <input type="text" /></dd>
		</dl>
		
		
		<h4 class="clear">Current Mental Health Treatment Goals: <span style="font-weight: normal; font-style: italic;">Morning</span></h4>
		<ol>
			<cfloop from="1" to="5" index="intRow">
				<li><input type="text" /></li>
			</cfloop>
		</ol>
		
		<h4 class="clear">Collaboration with Mental Health Professional, <span class="caption">COMAR 10.21.26.10 C(1)(a-b)(i-ii)</span></h4>
		<p style="margin-top: 0;"><em>Discuss consumer's condition, progress towards goals, and clinical issues</em></p>
		
		<table>
			<tr>
				<cfloop list="Who,Time,Recommendations" index="Label">
					<td>#Label#: <input type="text" /></td>
				</cfloop>
			</tr>
		</table>
		
		<h4>Goal Review w/ Consumer <span style="font-weight: normal; font-style: italic;">Evening</span></h4>
		<dl>
			<cfloop from="1" to="5" index="intRow">
				<cfsavecontent variable="dspSelect">
					<cfset Options = ["-- Please Select Status --","No Progress","Moderate Progress","Goal Accomplished"]>
					<select name="#intRow#">
						<cfloop from="1" to="#ArrayLen(Options)#" index="intOption">
							<option value="#intOption#">#Options[intOption]#</option>
						</cfloop>
					</select>
				</cfsavecontent>
				
				<dt>Goal ###intRow#: #dspSelect# </dt>
			</cfloop>
		</dl>
		
		<table width="100%">
			<tr>
				<td class="left">Consumer Signature: <input type="text" /></td>
				<td class="right">Evening Staff Signature: <input type="text" /></td>
			</tr>
		</table>
		
		<cfsavecontent variable="dspSelect">
			<cfset Options =["Disturbed Sleep","Unable to Sleep","Difficulty Falling Asleep","Pacing","Complaining","Seeking Interaction","Seeking Nourishment","Anxious"]>
			<select>
				<cfloop from="1" to="#ArrayLen(Options)#" index="intOption">
					<option value="#intOption#">#Options[intOption]#</option>
				</cfloop>
			</select>
		</cfsavecontent>
		
		<h4>Night Report #dspSelect#</h4>
		
		<table>
			<cfloop list="12:00AM,2:00AM,4:00AM,6:00AM" index="Time">
				<tr>
					<td class="right">#Time# Asleep: </td>
					<td style="padding-left:.5em;"><input type="radio" /> No <input type="radio" /> Yes</td>
					<td style="padding-left:5em;">Comments: <input type="text" /></td>
				</tr>
			</cfloop>
		</table><br />
		
		<table width="100%">
			<tr>
				<td class="left">Night Staff  Signature: <input type="text"/></td>
				<td class="right">Date: <input type="text" class="date" /></td>
			</tr>
		</table>
		
		<h4>Contact Notes, <span class="caption">COMAR 10.21.26.07 B(1)</span></h4>
		
		<table class="forms">
			<cfloop from="1" to="2" index="intRow">
				<tr>
					<cfloop list="Date,Agency,Person,Type,Contact,Number,Outcome,Add" index="ColumnHeader">
						<cfif intRow EQ 1>
							<cfif ColumnHeader IS "Add">
								<td class="transparent">#dspAddButton()#</td>
							<cfelse>
								<th class="title">#ColumnHeader#</th>
							</cfif>
						<cfelse>
							<td valign="top" style="padding: .5em .5em 0em .5em;"<cfif columnHeader IS "Add">class="transparent"</cfif>>
								<cfif ColumnHeader IS "Type">
									<select>
										<cfset Options = ["-- Please Select Type --","Telephone","Fax","Face-to-Face","E-mail","Mail"]>
										<cfloop from="1" to="#ArrayLen(Options)#"  index="intOption">
											<option value="#intOption#">#Options[intOption]#</option>
										</cfloop>
									</select>
								<cfelseif ColumnHeader IS NOT "Add">
									<input type="text" class="normal" />
								</cfif>
							</td>
						</cfif>
					</cfloop>
				</tr>
			</cfloop>
		</table>
		
		<h4 class="clear">Treatment Intervention/Services Provided <span style="font-size: .75em; font-weight:normal;">(Check all that apply)</span></h4>
		<table>
			<tr>
				<td>
					<cfset Labels = [
						"Suicide Prevention","Group Participation: Skills Building & Education","Health Management by Somatic Physician","Psychiatric Management by Psychiatrist",
						"Intervention to Enhance ADL Functioning","Case Management","Personal Planning/Goal Setting","Crisis Intervention Counseling",
						"Intervention for Medication Compliance","Intervention for Sympton Stabilization"
					]>
					
					<cfloop from="1" to="5" index="intLabel">
						<dl><dt><input type="checkbox" /> #Labels[intLabel]#</dt></dl>
					</cfloop>
				</td>
				<td>
					<cfloop from="6" to="10" index="intLabel">
						<dl><dt><input type="checkbox" /> #Labels[intLabel]#</dt></dl>
					</cfloop>
				</td>
			</tr>
		</table>
		
		<h4 class="clear">Daily Progress Note, <span class="caption">COMAR 10.21.26.07 B(2)(a-c)</span></h4>
		<p style="margin-top: 0em; font-style: italic;">
			Include information on Consumer's current symptoms and presentation, Treatment Goals (progress & adjustments), 
			Interventions provided & results, Discharge Planning, Case Management efforts, and collaboration with MH Professional
		</p>
		<p><textarea class="normal"></textarea></p>
		
		<table align="center" width="100%">
			<td>Consumer: <!--- #Consumer.firstName# #Consumer.lastName# ---></td>
			<td align="right">Date: <input type="text" class="date" /></td>
		</table>
	</fieldset>
</cfoutput>